The Effect of Inhaled Nitric Oxide on Pulmonary Ventilation-Perfusion Matching Following Smoke Inhalation Injury

Ogura, Hiroshi; Saitoh, Daizo; Johnson, Avery A.; Mason, Arthur D.; Pruitt, Basil A.; Cioffi, William G.

doi:10.1097/00005373-199412000-00004

Cited by 28 publications

(11 citation statements)

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“…INO has shown to be an ideal selective pulmonary vasodilator improving oxygenation and decreasing pulmonary artery pressure [123][124][125][126][127].…”

Section: Inhaled Nitric Oxidementioning

confidence: 99%

Pediatric acute lung injury

Dahlem

Aalderen

Bos

2007

Paediatric Respiratory Reviews

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“…INO has shown to be an ideal selective pulmonary vasodilator improving oxygenation and decreasing pulmonary artery pressure [123][124][125][126][127].…”

Section: Inhaled Nitric Oxidementioning

confidence: 99%

Pediatric acute lung injury

Dahlem

Aalderen

Bos

2007

Paediatric Respiratory Reviews

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“…In animal models, inhaled NO at concentrations of 5-80 parts per million (ppm) has been shown to produce selective and rapidly reversible pulmonary vasodilation [71,72], and in appropriate models, to improve V9/Q9 matching and increase arterial oxygenation [73][74][75]. Furthermore in experimental preparations, inhaled NO decreases both pulmonary oedema formation and neutrophil sequestration in the lung [75,76].…”

Section: Inhaled Nitric Oxidementioning

confidence: 99%

Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome

Moloney

Evans²

2003

Eur Respir J

115

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Pulmonary hypertension (PH) is a characteristic feature of the acute respiratory distress syndrome (ARDS). The magnitude of PH has been shown to correlate with the severity of lung injury in patients with ARDS independently of the severity of associated hypoxaemia and has an adverse prognostic significance.Early in the histopathological evolution of ARDS, pulmonary vasoconstriction, thromboembolism and interstitial oedema contribute to the development of PH, although pulmonary vascular remodelling probably occurs eventually. Intravenous vasodilator agents lead to an increase in intrapulmonary shunting and systemic hypotension, which can limit their therapeutic use, and have not been shown to improve survival. By contrast, rapidly metabolised vasodilators administered by inhalation induce selective pulmonary vasodilatation and decrease shunting, but again do not appear to confer a survival benefit.Research aimed at further understanding the mechanisms that underlie pulmonary hypertension, a characteristic feature of the acute respiratory distress syndrome, are expected to provide improvements in pharmacological interventions for the treatment of pulmonary hypertension in the acute respiratory distress syndrome.

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“…INO moderately improved ventilationperfusion matching and oxygenation by causing selective pulmonary vasodilation of ventilated areas in an ovine model of smoke inhalation injury [5]. This left open the question of whether INO would produce an improvement in outcome in human inhalation injury [26].…”

Section: Discussionmentioning

confidence: 99%

“…Another modality for the treatment of patients with lung failure is inhaled nitric oxide (INO), which improves perfusion of well-ventilated lung segments, and reduces pulmonary arterial hypertension [5]. Although FDA-approved for the treatment of term and near-term ( /34 weeks) neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension (INOmax † , INO Therapeutics, Inc., Clinton, NJ), the utility of INO as a therapy for ARDS is less well defined.…”

Section: Introductionmentioning

confidence: 99%

Delivery of nitric oxide by high-frequency percussive ventilation: System design and evaluation

Cancio

Galvez

Jordan

et al. 2006

Clinical Intensive Care

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Background : Inhaled nitric oxide (NO) improves oxygenation in patients with acute respiratory distress syndrome (ARDS), and may act synergistically with high-frequency ventilation. High-frequency percussive ventilation (HFPV) has improved outcome in patients with inhalation injury. Thus, a system for NO delivery via HFPV would be desirable, but has not yet been described. Methods : A mechanical test lung was used for this evaluation. HFPV was delivered by means of a Volumetric Diffusive Respiration ventilator (VDR-4 † ). Spontaneous breaths were simulated by means of a lever arm attached to the bellows of the test lung. NO was instilled continuously at a constant rate into a side port between the sliding venturi of the VDR-4 † and the endotracheal tube. Nitrogen dioxide (NO 2 ) and NO levels were measured electrochemically via ports located at the front and back of the test lung. Expired gas was scavenged, and environmental NO 2 levels were monitored. The ability of the system to provide constant NO levels, with NO 2 levels less than 1 ppm, was evaluated across a full range of ventilator settings and NO concentrations. Results : Target NO concentrations were easily achieved at all ventilator settings, with the following exception. At a low-frequency rate of 8 breaths/min or less, increased variability in the NO concentration was observed at the front (but not at the back) sampling port. Also, at a low-frequency rate of 6 breaths/min or less, NO 2 levels of 1.1 Á1.9 ppm were seen at the front sampling port only. Environmental levels of NO 2 did not increase above baseline. Scavenging did not alter ventilator operation. Conclusions : Delivery of NO via HFPV can be safely performed within acceptable parameters, provided the low-frequency rate is greater than 6 Á8 breaths/min.

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The Effect of Inhaled Nitric Oxide on Pulmonary Ventilation-Perfusion Matching Following Smoke Inhalation Injury

Abstract: Background: We previously reported that inhaled nitric oxide (NO) improved pulmonary function following smoke inhalation. This study evaluates the

Cited by 28 publications

References 0 publications

Pediatric acute lung injury

Pediatric acute lung injury

Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome

Delivery of nitric oxide by high-frequency percussive ventilation: System design and evaluation

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